ARRS 2022 Abstracts

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E1968. Computed Tomography Angiography Artifacts Mimicking Cardiovascular Emergencies
Authors
  1. Tomer Nawrocki; Staten Island University Hospital
  2. Alexander Song; Staten Island University Hospital
  3. Nassier Harfouch; Staten Island University Hospital
  4. George Michael; Staten Island University Hospital
  5. David Sarkany; Staten Island University Hospital
Background
Multidetector CT is designed to shorten image acquisition time, minimizing motion artifact. Intrinsic pulsations of the aortic root and heart, however, remain a source of motion that results in artifacts that mimic cardiovascular emergencies. Flow artifact and beam hardening artifact are additional pitfalls that can mimic cardiovascular emergencies.

Educational Goals / Teaching Points
The goal of this exhibit is to review frequently detected imaging artifacts on CT angiography, examine how these artifacts mimic cardiovascular emergencies, and discuss methods to eliminate or correct these imaging artifacts.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Ghosting of the ascending aorta, as a result of motion, appears as a curvilinear lucency in the region of the aortic root. This intimal pseudoflap simulates a life-threatening type 2A aortic dissection. Wing appearance of the coronary arteries due to cardiac motion can simulate aortic stenosis and an intraluminal thrombus. Inspiration during a pulmonary artery study can result in mixing of opacified contrast with non-opacified blood from the superior vena cava (SVC). This flow artifact creates the appearance of filling defects within the main pulmonary artery or its segmental branches. Such pseudothrombus can be eliminated by performing the study in the expiratory phase. Another flow-related artifact can be seen in the left atrial appendage as a result of turbulent flow, resulting in a filing defect that mimics a thrombus. Beam hardening artifact from dense contrast in the SVC creates a linear streak over the ascending aorta, mimicking a dissection. This is resolved by giving a saline chaser after contrast administration.

Conclusion
Motion, flow, and beam hardening artifacts are commonly encountered pitfalls in the use of multidetector CT that can mimic cardiovascular emergencies but can be corrected using specific imaging techniques.